Exercise therapy or angioplasty? A summation analysis

Objectives: lo compare the outcome of exercise therapy or angioplasty for t he treatment of patients with intermittent claudication. Design: a summation analysis. Methods: a search using MEDLINE and PUBMED between 1966 and April 1999 foll owed by a review of the manuscripts yielded 54 studies involving angioplast y and 27 studies involving exercise therapy for intermittent claudication. Studies were only included (12 angioplasty and nine exercise series) when r esults were available for patients with intermittent claudication alone, an d when outcome was assessed in terms of symptoms at a minimum of 6 months. Results: the total number of claudicants undergoing exercise therapy was 29 4 patients, with a mean symptomatic success rate of 38.4% and a mean improv ement in maximum walking distance of 189.7% at 6 months. The total number o f claudicants undergoing angioplasty was 2071, with a mean overall symptoma tic success rate of 76.6%. The mean overall complication rate was 9% and me an major complication rate was 2.7% for the angioplasty studies. Conclusion: although the result demonstrates an advantage of angioplasty ov er exercise therapy at 6 months, there is a small risk of major complicatio ns. However, comparison of studies was impaired due to disparity in patient numbers, limited follow-up time and lack of uniformity in outcome assessme nt. In order to achieve a valid comparison of these therapies in a future r andomised study, a validated disease-specific instrument for the assessment of symptomatic outcome for claudicants is required.